Children who consume a diet rich in fish, fruit and vegetables tend to have a lower risk for asthma and wheezing, while kids who eat several hamburgers a week may have a higher risk, according to new research published this week in the international respiratory journal Thorax.

The analysis, conducted by a team of international researchers led by epidemiologist Dr. Gabriele Nage of Germany’s Ulm University, included some 50,000 children from 20 countries around the world. Information about diet asthma and wheezing symptoms was collected through questionnaires given to parents of the 8 to 12-year-olds, while 30,000 children were tested for sensitivity to common allergens such as pollen to see if allergies might be contributing to asthma risk separately from diet.

The study authors found that, both in poorer and wealthier nations, children who consumed a Mediterranean diet — or one rich in fruits, vegetables and fish — were significantly less likely to suffer from asthma or wheezing. Among children from wealthier countries, this was particularly pronounced when the diet was high in fish; among those in poorer countries, the correlation was strongest when children ate higher concentrations of cooked greens.

Yet, while, across the board researchers found no correlation between meat-heavy diets and asthma risk, among children from wealthier countries there was a marked association between routine consumption of hamburgers — more than three times per week — and elevated risk for asthma.

The study authors say that the link between eating lots of burgers and facing an elevated risk for asthma is in keeping with previous research, but note that the discrepancy in this finding between wealthy and poorer nations suggests that burger consumption may be indicative of larger lifestyle elements. As they write:

“The frequency of burger consumption could be considered as a proxy for unknown lifestyle factors which may vary depending on social context, environmental and other lifestyle factors.”

Yet while further research may be necessary to develop a more nuanced view of the interaction between hamburger consumption and asthma risk, at the very least the current findings add to previous research underscoring the benefits of regularly eating fish, fruit and vegetables. As they conclude:

“Our observations support previous reports that the adherence to a ‘Mediterranean diet” may provide protection against wheeze and asthma in childhood. As consumption of fish, fruit and vegetables is widely recommended for prevention of cardiovascular disease and cancer, our findings suggest that [efforts to increase consumption of these foods] are unlikely to be harmful in relation to childhood asthma symptoms and may be beneficial in reducing the prevalence of wheezing among children in diverse settings around the world.”